Can Health Insurance Be Less Bad?

Oscar, an insurance start-up, aims to not crush the policyholder's soul.

For most people, insurance is a beautiful pain. Beautiful because being insured helps you live a longer, healthier life. A pain because, well, everything else to do with insurance. Let us count the ways, in the form of a typical insurance experience:

• Your toe hurts. But which kind of doctor should you see? 
• You log into a circa-1999 website and choose from a list of increasingly complicated-sounding specialties that end in "ologist."
• Make sure he's in your network! Remember, you're on the OAP Access Plus In-Network plan. It's an HMO.
• The website does not list the amounts the doctors charge. Will the x-ray be $1,000 or $200? It wouldn't be insurance without a good game of Entire Paycheck Roulette.
• Map view: View the locations of the specialists on a map tool that was apparently designed by colorblind middle schoolers.
• Go to the doctor. You're not religious, but you bring a rosary along just in case it increases the likelihood that this particular ICD-10 code will be covered.
• Your explanation of benefits comes via snail mail months later, but you can't decipher it (or worse, why the claim was denied.) You call the insurance company from your open-plan office the next day between the hours of 9 and 5. Hi coworkers! I have toe issues!
• Go back in for a follow-up visit, see the doctor for three-and-a-half minutes, and get the all-clear. Get charged another $40 co-pay as though you had broken your toe all over again.

Hold on hope, wounded hero. There's an insurance company that is trying to solve these issues—well, most of them. Among the things Oscar, a start-up health insurance company based in New York, offers: price-comparison shopping for doctors, e-mail communication with the insurance company, one-click prescription refills, easy-to-understand claims paperwork, free generic prescriptions, and the ability to suggest specialists based on a plain-English description of the symptoms, i.e. "my toe hurts."

Oscar

"One of the pieces of information that the insurance company has is what we negotiated with these doctors about what each procedure costs," said Mario Schlosser, an Oscar co-founder. "The insurance company is the one entity that has a lot of information about the members and about the provider systems. We connect all of these things in better ways to make things simple for you."

One way Oscar tries to save the policyholder (and itself) money is by keeping people out of the doctor's office. The company offers free phone calls with real doctors, home visits from nurses, and a concierge nurse service for pregnant women. When the baby is born, Oscar sends Mom a onesie.

"If you have access to a doctor at 3 a.m. at night, a ton of the stuff that you would typically go to the ER for can instead be solved by a doctor over the phone," Schlosser said.

One drawback: The plans are currently only available in New York City and a few surrounding counties. Oscar has plans to expand but didn't provide any specifics on when or where to. Right now, the company has 16,000 subscribers, or about 5 percent of the New York market, Schlosser said.

The plans aren't especially cheap—anything with a deductible under $2,000 costs around $500 per month, but the price depends on the subscriber's age and income. The bare-bones plan for people under 30, the $218-a-month "Secure" plan, has a deductible of over $6,000, but it comes with three free doctors' visits, the free doctor helpline, and gym membership discounts.

Another major limitation is that the plans are in-network only, meaning you can't see a doctor who doesn't accept Oscar unless you want to pay for it yourself.

All of Oscar's plans are compliant with Obamacare, and once the next Obamacare open enrollment period starts on November 15, New Yorkers can sign up either through HiOscar.com or Healthcare.gov. Schlosser says people who are eligible for the Obamacare subsidies will still qualify for them with Oscar.

Not everyone can get on Oscar. Not everyone probably should. But perhaps Oscar will, as "disruptive innovators" do, force other insurers to be a little more user-friendly. Or at least give us the email thing. And maybe the onesie.